Cervical facet hypertrophy is an increase in the volume of the vaginal part of the cervix associated with excessive development of connective tissue stroma, not accompanied by quantitative and structural changes in cells. Hypertrophy of the cervix may be accompanied by periodic pain in the lower abdomen, soreness during sexual intercourse, polymenorrhea, whites, a feeling of prolapse of the genitals, infertility. The diagnosis of cervical facet hypertrophy is based on colposcopy, hormonal examination, ultrasound of the pelvic organs with cervicometry. In the treatment of cervical facet hypertrophy, diathermocoagulation, electroexcision, cryodestruction, cervical amputation, reconstructive plastic surgery are used.
Cervical facet hypertrophy is a change in the size of the cervix due to thickening of the walls and its elongation (elongation). Hypertrophy may affect one or both lips of the vaginal part of the cervix. With a small degree of hypertrophy, it is possible to lengthen only the anterior part of the cervix, which protrudes forward, covers the posterior lip. With a significant amount of hypertrophy, the external pharynx of the cervix extends from the genital slit. Hypertrophy of the cervix can be observed both in the normal position of the uterus and when its bottom is lowered. This condition does not have a direct effect on the speed of pregnancy, but indirectly, as a manifestation of another gynecological pathology, it can reduce fertility and increase the possibility of complications during gestation.
Hypertrophy of the cervix can be a consequence of various pathological processes, but sometimes it can be caused by a genetic predisposition and anatomical features of the structure of a woman’s internal genitalia.
More often, cervical facet hypertrophy is formed against the background of a persistent inflammatory process of the cervical canal mucosa (endocervicitis), the transition of inflammation to a deeper stroma with the development of chronic cervicitis. Prolonged inflammation causes thickening and thickening of the cervix. Due to edema and swelling of the tissues of the cervix, obliteration of the excretory ducts of the glands occurs with a violation of the outflow of secretions and the formation of small, up to 6 mm in diameter, thin-walled retention vesicles – nabot cysts. Bubbles filled with a transparent secret can completely sink into the swollen stroma, forming a follicular form of hypertrophy.
In addition to inflammation, hypertrophy can be provoked by repeated damage to the cervix during childbirth or during abortions (in the absence of full-fledged treatment of microcracks and ruptures). In this case, there is an inversion of the mucous membrane of the cervical canal into the vaginal cavity. The effect of the unfavorable acidic environment of the vagina on the endocervix leads to the appearance of edema, an increase and compaction of the mucosa and underlying tissues, the proliferation of epithelium, the appearance of pathological secretions with a possible admixture of pus or blood.
Regeneration of the tissues of the cervical canal and stroma at the site of damage proceeds with the formation of scars, leading to an increase in the size of the cervix, loss of its inherent elasticity. Post-traumatic violation of trophic, microcirculation and metabolic processes of the hypertrophied cervix create favorable conditions for the development of infection, contributing to the recurrence of inflammation, the development of background precancerous diseases. Changes in the hormonal background, as well as myomatous nodes located near or with the capture of the cervix (cervical and cervical) can also cause its hypertrophy.
The formation of cervical facet hypertrophy goes through several stages:
- Stage I – the external pharynx of the cervix is located above the genital slit;
- Stage II – the external pharynx descends to the level of the genital slit, but does not protrude beyond it;
- Stage III – hypertrophied cervix extends beyond the labia.
At the initial stage of development, cervical facet hypertrophy does not manifest itself clinically and subsequently has no specifically pronounced symptoms. In the case of prolonged cervical facet hypertrophy, the patient may be disturbed by intermittent, intermittent unpleasant sensations or pulling pains in the lower abdomen, groin and sacrum, soreness during sexual intercourse, polymenorrhea, leukorrhea. Infertility may occur without obvious reasons. The main symptom of stage II –III hypertrophy of the cervix is a feeling of sagging or prolapse of the internal genitalia.
In case of cervical facet hypertrophy, a comprehensive gynecological examination is performed, including examination with mirrors, simple and extended colposcopy, assessment of hormonal status, ultrasound of the pelvic organs with cervicometry, cytological examination of smears from the cervix.
Additionally, cervicoscopy, diagnostic curettage of the cervical canal, targeted biopsy of the cervix, PCR diagnostics can be used. Visualization allows you to assess the condition of the internal genitalia, determine the size and structure of the cervix, its location relative to other pelvic organs, blood flow characteristics, changes in the endocervix. Differentiate cervical facet hypertrophy from cervical cancer, ectopic cervical pregnancy.
Methods of treatment of the cervix are selected by the gynecologist individually, taking into account the nature of the background pathology that provokes the disease. With a mild degree of cervical facet hypertrophy in the absence of risk factors, observation with annual colposcopy, a ban on lifting weights (more than 5 kg) are indicated. In case of cervical facet hypertrophy in combination with the inflammatory process of the cervical canal or cervical fibroids, conservative tactics are used in gynecology – antibiotic therapy, intensive immunostimulation or hormone therapy. With cervical facet hypertrophy, the use of minimally invasive techniques – diathermocoagulation, electroexcision and cryodestruction of excess tissue is effective. Opening of nabotovye cysts is not always effective and is contraindicated in acute and subacute inflammation. Promising methods of treating cervical facet hypertrophy include radio wave conization.
With significant hypertrophy, surgical intervention is indicated – partial resection, amputation (wedge-shaped, cone-shaped, high) or complete removal of the cervix, as well as reconstructive plastic correction with mandatory colpoperineolevatoroplasty. It is important to determine the optimal amount of tissue to be excised. The operation allows you to reduce the length and volume of the cervix, increase reproductive potential and restore sexual activity. With a sharp hypertrophy of the cervix, combined with uterine prolapse, hysterectomy (removal of the uterus) is performed in patients who do not plan childbirth together with the removal of the cervix.
Prognosis and prevention
In the absence of treatment, cervical facet hypertrophy can have negative consequences. Advanced cases can lead to mechanical or hormonal infertility, bleeding (with cervical fibroids or spontaneous breakthrough of nabot cysts), dystrophic transformation, the development of cervical leukoplakia and precancerous conditions.
Prevention is based on the prevention of diseases of the cervix, rational nutrition, sports (including Kegel exercises to strengthen the pelvic floor muscles during pregnancy and after childbirth), careful management of childbirth to avoid birth injuries, timely treatment of inflammatory processes of cervix.